How Medicare covers Alzheimer’s disease

Dear Savvy Senior,

What exactly does Medicare cover when it comes to Alzheimer’s disease? My husband was recently diagnosed with early-stage Alzheimer’s, and we would like to find out what’s covered and what isn’t.

-Planning Ahead

Dear Planning,

I’m very sorry to hear about your husband’s diagnosis, but you’ll be happy to know that most medical costs to treat beneficiaries with Alzheimer’s disease are covered by Medicare. Unfortunately, longterm custodial care costs that most patients eventually need are not. Here’s a breakdown of what Medicare does and doesn’t cover when it comes to Alzheimer’s disease, along with some tips that can help you plan ahead.

Medical care

For the most part, ongoing medical care to diagnose and treat Alzheimer’s disease is covered by Medicare Part B, including visits to primary care doctors and specialists, lab tests, speech and occupational therapy, home health care and outpatient counseling services. Medicare pays 80% of these costs, and you will be responsible for the remaining 20% after you’ve met your annual $233 Part B deductible.

Sixty days of inpatient hospital care is also covered under Medicare Part A after you pay a $1,556 deductible. Beyond 60 days, a daily coinsurance fee is added.

Medications

Most Alzheimer’s medications are covered under Medicare’s Part D prescription drug plans, but coverage varies so check his plan’s formulary. The only exception is Aduhelm, the controversial new drug that is estimated to cost $28,200 per year. Medicare Part B will only cover this drug if your husband is enrolled in a clinical trial.

Hospice

In the final stages of the disease, Medicare Part A covers nearly all aspects of hospice care, including doctor services, nursing care, drugs, medical equipment and supplies, physical and occupational therapy, homemaker services, counseling and respite care. To qualify, a doctor must certify that a patient has six months or less to live.

Other insurance and assistance

If your husband is enrolled in original Medicare and he doesn’t have a supplemental insurance (Medigap) policy, you should consider getting him one. A Medigap plan will help pay for things that aren’t covered by Medicare, like copayments, coinsurance and deductibles. To search for plans in your area, go to Medicare. gov/plan-compare and click on “Medigap policy only.”

Or, if you’re enrolled in a Medicare Advantage plan (like an HMO or PPO), his plan must provide him at least the same coverage as original Medicare does. Some advantage plans may also offer additional coverage for home care services.

If you can’t afford your Medicare out-of-pocket costs or need help with medication expenses, there are Medicare Savings Programs and the

Extra Help program that provide financial assistance for medications.

To learn more, see Medicare.gov/your-medicare-costs/Medicare.gov/your-medicare-costs/get-help-paying-costs.

You can also get help through your State Health Insurance Assistance Program (see ShipHelp.org or call 877839-2675), which provides free Medicare and long-term care counseling.